Post op Care

Postoperative care is the management of a patient after surgery.

Phases of Post op Care

• Immediate: Post anesthesia
• Intermediate: Hospital Stay
• Convalescent: After discharge to full recovery

Aims of Phase 1&2

• Homeostasis
• Analgesia
• Prevention and early detection of complications

Monitoring

• Monitor Vitals: Pulse, Bp, temperature, resp rate, O2 sat, consciousness
• Maintain Input and Output

Analgesia

• Analgesia as per analgesic step ladder after taking into consideration pts hepatic , renal status etc
• Tricyclic antidepressants and psychotherapy (stress relaxation, biofeedback etc) an be used as adjuvants

Post Op Complications

• Fever
• Urinary Retention
• Constipation
• Wound Problems
• Respiratory complications
• DVT

Fever

• Early: Systemic response to trauma of surgery
• 1-3 days: UTIs, IV site infection
• >5 days: wound infection, abscess, RTIs

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• Temprature charting
• Thorough physical examination to find cause
• Tepid sponging

Wound Complications

• Infections
• Dehisence
• Hematomas

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• Change dressing daily
• Look for signs of infection
• IV antibiotics

Respiratory Complications

• Atelectasis
• Pneumonia
• Aspiration
• Pulmonary Edema
• Acute Respiratory Failure

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• Post op breathing exercises reduce incidence
• Manage pain and abdominal distension
• Early mobilisation

Urinary Retention

• Causes: recumbent position, effects of anesthesia and opiods, inactivity, anxiety
• Monitor input and output
• Assess bladder distension
• All else fails catheterize

Constipation

• Organic: due to partial obstruction of lumen
• Functional: defective movements of colonic musculature or decreased bulk of faeces

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• Auscultate bowel sounds every 4 hours
• Assess abd for distension
• Determine whether pt is passing flatus
• Encourage ambulation, fluid intake
• If no bm for 3-4 days then suppositories or enema

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• Change patients posture regularly if pt himself is unable to do so
• Assess risk of DVT and take appropriate actions

Patient Education

• Expected outcomes
• Immediate post operative changes
• Written instructions like: wound care, dietary recommendations, medications, follow up